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Work onClinician Well-Being
at the National Academies
Sharyl Nass, Ph.D.Director, Board on Health Care Services
Health and Medicine DivisionNational Academies of Sciences, Engineering, and Medicine
Action Collaborative on Clinician Well-Being and Resilience
Overarching Goals:• Raise visibility of clinician burnout, depression,
stress, and suicide
• Improve baseline understanding of challenges to clinician well-being
• Advance evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver
Make up of the Collaborative~65 participants representing:
• Medicine, nursing, pharmacy, dentistry• Professional societies and membership
organizations• Government agencies• Health IT vendors• Large health care centers• Payers• Researchers• Trainees and early career professionals• Patient and consumer perspectives
Steering CommitteeVictor J. Dzau, National Academy of MedicineDarrell G. Kirch, Association of American Medical CollegesThomas J. Nasca, Accreditation Council for Graduate Medical Education
Steven Bird, Society for Academic Emergency MedicineNeil Busis, American Academy of NeurologyPamela Cipriano, American Nurses AssociationRobert Harbaugh, Society of Neurological SurgeonsArt Hengerer, Federation of State Medical BoardsSandeep Kishore, Icahn School of Medicine at Mount SinaiClifton Knight, American Academy of Family PhysiciansLois Margaret Nora, American Board of Medical SpecialtiesBarry Rubin, University Health NetworkDaisy Smith, American College of Physicians
Working Groups1. Research, Data, and Metrics
2. Conceptual Model
3. External Factors and Work Flow
4. Messaging and Communications
5. External Publications and Art Show
Research, Data, and Metrics• Completed:
– Discussion Paper: “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care”
– Compilation of validated survey instruments to assess work-related dimensions of well-being
– Discussion Paper: “A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being”
• Forthcoming: – Financial cost of burnout among nurses – Gender differences in burnout and
related factors
Factors Affecting Clinician Well-Being and Resilience
SOCIETY & CULTURE• Alignment of societal expectation and clinician’s role • Culture of safety and transparency• Discrimination and overt and unconscious bias• Media portrayal • Patient behaviors and expectations• Political and economic climates• Social determinants of health • Stigmatization of mental illness
External Factors
RULES & REGULATIONS• Accreditation, high-stakes assessments, and publicized
quality ratings • Documentation and reporting requirements • HR policies and compensation issues• Initial licensure and certification • Insurance company policies • Litigation risk • Maintenance of licensure and certification • National and state policies and practices• Reimbursement structure• Shifting systems of care and administrative requirements
ORGANIZATIONAL FACTORS• Bureaucracy• Congruent organizational mission and values• Culture, leadership, and staff engagement• Data collection requirements• Diversity and inclusion • Harassment and discrimination • Level of support for all healthcare team members
LEARNING/PRACTICE ENVIRONMENT• Autonomy • Collaborative vs. competitive environment• Curriculum• Health IT interoperability and usability/Electronic health
records• Learning and practice setting• Mentorship program• Physical learning and practice conditions• Professional relationships• Student affairs policies • Student-centered and patient-centered focus• Team structures and functionality• Workplace safety and violence
HEALTH CARE RESPONSIBILITIES• Administrative responsibilities• Alignment of responsibility and authority• Clinical responsibilities• Learning/career stage• Patient population• Specialty related issues• Student/trainee responsibilities• Teaching and research responsibilities
ORGANIZATIONAL FACTORS• Power dynamics• Professional development opportunities • Scope of practice• Workload, performance, compensation, and value
attributed to work elements
External Factors and Work Flow• Completed:
– Discussion paper: Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout”
– Discussion paper: “A Vision for a Person-Centered Health Information System”
– Discussion paper: “Implementing Optimal Team-Based Care to Reduce Clinician Burnout”
• Forthcoming:– Streamlined suggestions to CMS re.
E/M documentation guidelines
Healthy clinicians provide better patient care. Let’s build a better system that helps clinicians thrive.
nam.edu/clinicianwellbeing
Knowledge Hub is organized around three main topics
• Causes: Organizational factors, learning environment, practice environment, society and culture, personal factors, rules and regulations
• Effects: Safety and patient outcomes, clinician well-being, turnover and reduction of work effort, health care costs
• Solutions: Organizational strategies, measuring burnout, individual strategies
Case Studies in Spring 2019• 5 case studies highlighting programs that are engaging
in promising practices to reduce clinician burnout and improve well-being
• Goal is to provide actionable guidance for organizations seeking to implement clinician well-being programs
• Diverse array of programs
• Criteria for inclusion
• Community of shared learning; webinars
• > 350 submissions including paintings, music, and written word• 10 art pieces available for traveling art show • 100 featured in a permanent digital gallery
Expressions of Clinician Well-Being nam.edu/expressclinicianwellbeing
Recent Workshops
Graduate Medical Education Outcomes and Metrics
See: www.nap.edu
Improving Care to Prevent Suicide
Consensus study:Systems Approaches to Improve Patient Care
by Supporting Clinician Well-Being
An ad hoc committee will examine:• causes of clinician burnout • consequences for both clinicians and patients• interventions to support clinician well-being and resilience• components of the clinical training and work environment • a variety of care settings• potential systems interventions to mitigate burnout.
The committee will identify:• promising tools and approaches to support clinician well-being• gaps in the evidence base• a research agenda to address areas of uncertainty.
Study Sponsors• Accreditation Council for
Graduate Medical Education• American College of
Occupational and Environmental Medicine
• American Hospital Association• The Arnold P. Gold Foundation• Association of American Medical
Colleges• BJC HealthCare• Cedars-Sinai Medical Center• Duke University Hospital• Gordon and Betty Moore
Foundation• Johns Hopkins Health System
• Josiah Macy Jr. Foundation• Keck School of Medicine of USC• Medical College of Wisconsin• Montefiore Medicine• The Doctors Company Foundation• The Mont Fund• The Ohio State University• The State University of New York
System• Tulane University• University of Florida• University of Illinois Hospital and
Health Sciences System
• University of Massachusetts Medical School
• University of Michigan• University of New Mexico
Health Sciences Center• University of Utah Health• University of Virginia Medical
Center and University of Virginia School of Medicine
• Vanderbilt University Medical Center
• Washington University School of Medicine
• Yale School of Medicine andYale New Haven Health System
Consensus Committee Members
Elisabeth BelmontNeil BusisM. Lynn CrismonLiselotte DyrbyePooja KinkhabwalaWanda LipscombSaranya LoehrerM.A.J. Lex MacNeil
Jose PaganSharon PappasCynda RushtonTait ShanafeltGeorge ThibaultVindell WashingtonMatthew Weinger
Christine Cassel, Co-ChairPascale Carayon, Co-Chair
Consensus StudyThe committee will consider key components of the health care system:• factors that influence clinical workflow, workload, and human-systems
interactions;• the composition and function of care teams;• outcomes-based payment and quality improvement programs;• current and potential use and impact of technologies and tools; and• regulations, guidance, policies, and accreditation standards.
To support the well-being of all clinicians and trainees on the care team, prevent clinician burnout, and facilitate high-quality patient care,the committee will issue recommendations for system changes to:• streamline processes and reduce complexity• minimize the burden of documentation requirements• enhance workflow and teamwork
Submit written comments to:[email protected]
www.nas.edu/supportingclincianwellbeing
Input welcomethroughout the study
Vision for the Future
• A campaign for systems change• Evidence-based solutions• Leveraging networks of organizations
committed to improving clinician well-being • Building a community of empowerment• Supporting healthy clinicians and high-
quality patient care
Join the movement!
To provide an opportunity for organizations to discuss and share plans of action to reverse clinician burnout and promote clinician well-being, the NAM is collecting statements describing organizational goals or commitments to action.
nam.edu/SupportClinicianWellBeing
Attend our next public meeting! The next public meeting is focused on redesigning the
clinical learning environment.
This meeting will take place on Wednesday, May 29th at the ACGME headquarters in Chicago, IL
For meeting updates, visit nam.edu/CW
Thanks to the Staff Team!
Collaborative
Charlee AlexanderIvory ClarkeMariana ZindelImani RickerbyKyra Cappelucci
Consensus Study
Laura AuippaMarc MeisnereRajbir KaurHeather KreidlerToby Warden
